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Non-communicable diseases: Challenges in treatment

Shivam D Thakore
Wednesday, November 22, 2017, 08:00 Hrs  [IST]

Non-communicable diseases (NCDs) are considered as the silent killer in the medical science. They are briefly classified as diseases which are not spread from person to person with handshakes, sneezing, blood transfusion, or similar household things of patient. Over and above they are neither caused by infectious agents nor are they spread due to infections. Generally, they are termed as non-transmissible or NCDs. Examples of the most prevalent NCDs are cardiovascular disease, diabetes, cancers, stroke, osteoporosis, kidney disorders, and neurological disorders including Alzheimer’s disease, Parkinson’s disease, etc. As time passes, the prevalence of NCDs is creating complexity in the mind of medical professionals as patients suffering from NCDs are increasing with every year. While the NCD patients are increasing with leaps and bounds, there are no breakthroughs in treatment or management of NCDs. Inability to prevent or cure or manage the NCDs, irrespective of reason has put tremendous pressure on medical and pharmaceutical scientists. However, the search is constantly being going on for finding the ways to improve the life of patient of NCDs but due to some or other reasons (including financial, socio-economic, political, and government interest) the progress in NCDs is limited (including understanding of latest theories in pathophysiology of disease progression, identifying new therapeutic targets for pharmaceutical formulators to inventing new chemical entities, improving the conventional methodology of treatment using nanotechnology based treatment, and identifying the molecular mechanism of disease progression and inventing drug moieties accordingly).

Alzheimer's and other neurological disorders
Alzheimer’s disease (AD) is a progressive neuro-degenerating disorder which leads to gradual loss in memory. It is typically characterized by loss of cholinergic activity, presence of amyloid and tau proteins deposits in brain areas and increased levels of reactive oxygen species with serious neuro-inflammation which leads to neuronal cell death. It is the most common form of dementia. AD is most prevalent in elderly patient beyond age 65. The most concerned point to be noted is the symptoms of AD are unidentified for many years before diagnosis while actually AD has progressed to severe stage when it has got diagnosed. There is need of advanced technology for improving the diagnostic techniques which will prove its worth by early treatment commencement for AD. Treatments of any neurological disorders are limited by sufficient therapeutic concentrations of drug in central nervous system. The main culprit behind low brain levels of neuroleptic drugs is Blood Brain Barrier (BBB). Most of the therapeutic molecules (either endogenous or exogenous) are unable to cross BBB due to tight epithelial junction cells of BBB. BBB is highly selective barrier in human body that restricts transport of large molecules and 98% of small molecules. Now this restrictive criterion is beneficial as no toxins can cross BBB leading to healthy brain without infection for many times. However, this point is matter of worry for the pharmaceutical scientist as even useful drugs (synthetic or biological origin) are refrained from crossing the BBB. This process interrupts the treatment of central nervous system disorders as sufficient drug concentration is not buildup in brain. This poses a great hurdle in delivering the therapeutic agents to brain areas which limits the treatments for AD and other neurological disorders.

Cancer is the most common group of progressive disease which has highest spreading rates. The cell proliferation of human body when gets abnormal, leads to formation of tumor or mass/cluster of cells which is defined as cancer. Some tumors has ability to spread to other parts of body making it malignant type cancer while others are confined to specific organ or tissue only making it benign cancer. Cancer is the most difficult disease to treat due to its malignancy. Treatment with any therapeutic agent is limited due to the spreading nature of malignant cancer cells. Blood cancer is most difficult to treat due to the constant motion of tumour. Further, obesity, tobacco consumption and diagnosis of cancer pose a great challenge in successful treatment of cancer. Several developed countries are having high prevalence of obesity leading to dramatic cell proliferation and DNA abnormality due to tobacco consumption. This both the factors can support the cell proliferation, which, if abnormal, leads to initial stage of cancer. Hence, only medical treatment is not sufficient to treat cancer but adjunct therapy in form of life style modification, healthy food habits, minimized alcohol and tobacco consumption is also needed for faster treatment and recovery from this deadly disease.

Diabetes mellitus (DM)
Diabetes mellitus is the group of disease caused by the metabolic imbalance in human body. They are accompanied by increased levels of sugar in blood which is denoted in medical language by hyperglycemia. Diabetes can caused serious short and long term complications when left untreated. The rise in blood sugar level may be due to the malfunctioning of pancreas to produce insulin (Type 1 DM) or development of resistance for insulin in a cell (Type 2 DM). Type 1 DM is rather incurable and has no alternative in treatment except external insulin therapy. In the majority of cases diabetes is of Type 2 which leads to impaired response to the insulin, produced by pancreas. Heavy exercise is major contributor in prevention of Type-2 DM which is not very familiar with the humans of Indian origin. One of the research studies suggests that the excessive fatty tissue in the body supports the diabetic conditions. Constantly active persons, regular exercise and physical stress of body needs the high energy which can be generated from glucose in body. As heavier the physical stress on human body is, higher the energy needed by body, which utilizes increased amount of glucose. This way the excess glucose in human body can be consumed which is adjunct to the medical treatment of DM. Apart from sedentary life style, unhealthy diet contributes significantly in prevalence of glucose impaired utilization in adults as well as child. Simple diet including diet with zero or minimum sugar, avoidance of sweetened drinks and junk foods which consists of synthetic material for taste can alleviate the diabetes conditions. These alternatives when not followed thoroughly can lead to increase in the weight, leading to 30% higher chances of Type 2 DM. Unawareness or avoidance of these non-pharmacological treatments poses great challenge in the treatment of DM.

The most globally prevalent NCDs were focused here superficially highlighting the points which impede their successful treatment. Looking at the statistics released (data not shown) by World Health Organization, one can get idea that at what pace these NCDs are engulfing the population worldwide. Thanks to almighty, that these are not communicable type of disease else it would get spread within fraction of second converting it into an epidemic. Challenges mostly the medical community face, is the improper life style and non-pharmacological therapy unawareness for disorders. It is a fact that in addition to the pharmacological treatment, non-pharmacological therapy plays an adjunct role in eradication of root cause of disease. Many time non-drug therapy synergies the pharmacological treatment leading to faster cure or prevention. As a part of awareness campaign, social organizations, volunteers, government agencies, medical and pharmacy councils should now focus on the making the people confront with the above explained non-pharmacological therapy and its benefits which can prove the worth of any drug treatment. They should be informed about modifications in the current life style of the patients which puts them at elevated risk of developing or improper treatment of NCDs.

(Author is with A. R. College of Pharmacy &
G. H. Patel Institute of Pharmacy)


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